NCDR Study Examines Predictors and Outcomes of AKI in PCI Patients
Acute kidney injury (AKI) after a percutaneous coronary intervention (PCI) has become a common and serious complication that results from the procedure. With limited therapeutic options available once AKI develops, even small increases in a patient’s serum creatinine can bring about lengthy hospital stays and excess cost in treatment. However, the exact rate of occurrence after PCI is quite unclear. With antiquated intel using varying definitions of AKI, making it difficult to compare its frequency across different studies and populations, documented incidences fall anywhere between 3-19 percent.
A new analysis published Jan. 20 in JACC: Cardiovascular Interventions attempted to use a contemporary standard of classification of the condition to better identify and treat at-risk patients. Utilizing data from the CathPCI Registry, a team of researchers led by Thomas Tsai, MD, MSc, Institute for Health Research, Kaiser Permanente Colorado and the University of Colorado, examined the records of over 985,000 consecutive patients undergoing PCIs from June 2009 through June 2011.
Of these patients AKI developed in over 69,600 (7.1 percent): 56,850 (6 percent) with AKI stage 1; 4,534 (.5 percent) with AKI stage 2; and 2,441 (.3 percent) with AKI stage 3, and 3,005 (.3 percent) patients developed AKI-D, requiring new dialysis. The study’s results showed that factors most strongly associated with the development of AKI ST-segment elevation myocardial infarction (STEMI) presentation, severe chronic kidney disease, and cardiogenic shock. Patients with AKI or AKI-D also experienced very high rates of in-hospital bleeding, myocardial infarction, and death. Ultimately the in-hospital mortality rate for patients with AKI was 9.7 percent and 34 percent for requiring dialysis.
Hoping that their study can be compared with other clinical cohorts and validate the use of such criteria for AKI as an independent predictor of adverse events, co-author Frederick Masoudi, MD, MSPH, FACC, NCDR senior medical officer, notes, "This is another key study that illustrates the strength of registries to understand patient outcomes in contemporary practice and will form the foundation of targeted efforts to improve these outcomes. In many cases, especially for acute coronary syndromes, the risks of the procedure, including that of AKI, will be worth taking because of the benefits of the procedure. This study, however, provides us with a clear understanding of the risk for a specific and relatively common complication and identifies the groups of patients most likely to develop AKI. Information on AKI outcomes in patients undergoing PCI in the Registry are currently fed back to participating hospitals, providing them with the data necessary to reduce the risks of AKI whenever possible."
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